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Author: Brian S McGowan, PhD

ABSTRACT: Edgar Dale’s Pyramid of Learning in medical education: A literature review

Background: Edgar Dale’s Pyramid of Learning and percentages of retained learning are cited in educational literature in a range of disciplines. The sources of the Pyramid, however, are misleading. Aims: To examine the evidence supporting the Pyramid and the extent to which it is cited in medical education literature. Methods: A review of literature (1946-2012) based on a search utilising Academic Search Complete, CINAHL, Medline and Google Scholar conducted from September to November 2012. Results: A total of 43 peer-reviewed medical education journal articles and conference papers were found. While some researchers had been misled by their sources, other authors’ interpretations of the citations did not align with the content of those citations, had no such citations, had circular references, or consulted questionable sources. There was no agreement on the percentages of learning retention, in spite of many researchers’ citing primary texts. Discussion and conclusion: The inappropriate citing of the Pyramid and its associated percentages in medical education literature is widespread and continuous. This citing undermines much of the published work, and impacts on research-based medical education literature. While the area of learning/teaching strategies and amount of retention from each is an area for future research, any reference to the Pyramid should be avoided.

via Edgar Dale’s Pyramid of Learning in medical educat… [Med Teach. 2013] – PubMed – NCBI.

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ABSTRACT: Collaborative networks for both improvement and research.

Moving significant therapeutic discoveries beyond early biomedical translation or T1 science and into practice involves: (1) T2 science, identifying “the right treatment for the right patient in the right way at the right time” (eg, patient-centered outcomes research) and tools to implement this knowledge (eg, guidelines, registries); and (2) T3 studies addressing how to achieve health care delivery change. Collaborative improvement networks can serve as large-scale, health system laboratories to engage clinicians, researchers, patients, and parents in testing approaches to translate research into practice. Improvement networks are of particular importance for pediatric T2 and T3 research, as evidence to establish safety and efficacy of therapeutic interventions in children is often lacking. Networks for improvement and research are also consistent with the Institute of Medicine’s Learning Healthcare Systems model in which learning networks provide a system for improving care and outcomes and generate new knowledge in near real-time. Creation of total population registries in collaborative network sites provides large, representative study samples with high-quality data that can be used to generate evidence and to inform clinical decision-making. Networks use collaboration, data, and quality-improvement methods to standardize practice. Therefore, variation in outcomes due to unreliable and unnecessary care delivery is reduced, increasing statistical power, and allowing a consistent baseline from which to test new strategies. In addition, collaborative networks for improvement and research offer the opportunity to not only make improvements but also to study improvements to determine which interventions and combination of strategies work best in what settings.

via Collaborative networks for both improvement and r… [Pediatrics. 2013] – PubMed – NCBI.

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ABSTRACT: Pediatric collaborative improvement networks: background and overview.

Multiple gaps exist in health care quality and outcomes for children, who receive <50% of recommended care. The American Board of Pediatrics has worked to develop an improvement network model for pediatric subspecialties as the optimal means to improve child health outcomes and to allow subspecialists to meet the performance in practice component of Maintenance of Certification requirements. By using successful subspecialty initiatives as exemplars, and features of the Institute for Healthcare Improvement’s Breakthrough Series model, currently 9 of 14 pediatric subspecialties have implemented collaborative network improvement efforts. Key components include a common aim to improve care; national multicenter prospective collaborative improvement efforts; reducing unnecessary variation by identifying, adopting, and testing best practices; use of shared, valid, high-quality real-time data; infrastructure support to apply improvement science; and public sharing of outcomes. As a key distinguisher from time-limited collaboratives, ongoing pediatric collaborative improvement networks begin with a plan to persist until aims are achieved and improvement is sustained. Additional evidence from within and external to health care has accrued to support the model since its proposal in 2002, including the Institute of Medicine’s vision for a Learning Healthcare System. Required network infrastructure systems and capabilities have been delineated and can be used to accelerate the spread of the model. Pediatric collaborative improvement networks can serve to close the quality gap, engage patients and caregivers in shared learning, and act as laboratories for accelerated translation of research into practice and new knowledge discovery, resulting in improved care and outcomes for children.

via Pediatric collaborative improvement networks: bac… [Pediatrics. 2013] – PubMed – NCBI.

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ABSRACT: Understanding the Etiology of Prescription Opioid Abuse

Although studies on the initiation of substance abuse abound, the body of literature on prescription opioid abuse POA etiology is small. Little is known about why and how the onset of POA occurs, especially among high-risk populations. In this study we aimed to fill this important knowledge gap by exploring the POA initiation experiences of 90 prescription opioid abusers currently in treatment and their narrative accounts of the circumstances surrounding their POA onset. This research was conducted within a storyline framework, which operates on the premise that the path to drug abuse represents a biography or a process rather than a static condition. Audiotapes of in-depth interviews were transcribed, coded, and thematically analyzed. Analyses revealed the presence of four trajectories leading to POA. This study adds to the limited research on POA etiology by not only illuminating the psychosocial factors that contribute to POA onset, but also by situating initiation experiences within broader life processes. The study findings provide crucial insights to policymakers and interventionists in identifying who is at risk for POA, and more important, when and how to intervene most efficaciously.

via Understanding the Etiology of Prescription Opioid Abuse.

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RESOURCE: Simple Techniques for Applying Active Learning Strategies to Online Course Videos

From Web-enhanced face-to-face courses to MOOCs, flipped, blended, and fully online courses, videos are an integral component of today’s educational landscape—from kindergarten all the way through higher education.
But there’s a big difference between watching a video and learning something from it. Videos are great for presenting visual information and emotional appeals, but not particularly effective at diving below the surface of non-visual theoretical or abstract topics or for driving critical thinking. What’s more, any video presented in class must compete for attention and memory with the five-plus hours the typical student spends outside of class watching television programs, movies, and other onscreen entertainment. (Nielsen, 2013)
To help increase the educational effectiveness of an online course video, consider applying one or more of the following active learning strategies.

via Simple Techniques for Applying Active Learning Strategies to Online Course Videos | Faculty Focus.

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MANUSCRIPT: Resident physicians as human information systems: sources yet seekers

Objective To characterize question types that residents received on overnight shifts and what information sources were used to answer them.

Materials and Methods Across 30 overnight shifts, questions asked of on-call senior residents, question askers’ roles, and residents’ responses were documented. External sources were noted.

Results 158 of 397 questions (39.8%) related to the plan of care, 53 (13.4%) to medical knowledge, 48 (12.1%) to taskwork knowledge, and 44 (11.1%) to the current condition of patients. For 351 (88.4%) questions residents provided specific, direct answers or visited the patient. For 16 of these, residents modeled or completed the task. For 216 questions, residents used previous knowledge or their own clinical judgment. Residents solicited external information sources for 118 questions and only a single source for 77 (65.3%) of them. For the 118, most questions concerned either the plan of care or the patient’s current condition and were asked by interns and nurses (those with direct patient care responsibilities).

Discussion Resident physicians serve as an information system and they often specifically answer the question using previous knowledge or their own clinical judgment, suggesting that askers are contacting an appropriately knowledgeable person. However, they do need to access patient information such as the plan of care. They also serve an educator role and answer many knowledge-related questions.

Conclusions As synchronous verbal communications continue to be important pathways for information flow, informaticians need to consider the relationship between such communications and workflow in the development of healthcare support tools.

via Resident physicians as human information systems: sources yet seekers — Bass et al. 20 (4): 736 — Journal of the American Medical Informatics Association.

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RESOURCE: The Pedagogy of MOOCs

There is a great deal of energy, enthusiasm, and change happening in today’s education sector. Existing and new education providers are leveraging the Internet, ICT infrastructure, digital content, open licensing, social networking, and interaction to create new forms of education. Open Educational Resources (OER) (including open textbooks), Open Access, and Massive Open Online Courses (MOOCs) have all gained traction as significant drivers of education innovation.

MOOCs in particular are stimulating widespread discussion around the potential to reach and serve hundreds of thousands of learners who would otherwise not have access to education. Like all of you I’ve been tracking MOOC’s with great interest.

While MOOC’s have attracted huge attention, and hype, for supporting massive enrollments and for being free its the pedagogical aspects of MOOC’s that interest me the most.

via The Pedagogy of MOOCs | Paul Stacey.

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ABSTRACT: Knowledge transfer in surgery: skills, process and evaluation

INTRODUCTION:
Knowledge transfer is an essential element in the management of surgical health care. In a routine clinical practice, surgeons need to make changes to the health care they provide as new clinical evidence emerges.
MATERIALS AND METHODS:
The information was derived from the authors’ experience and research in evidence-based practice, searching of the literature, teaching and organisation of various national and international workshops on evidence-based medicine.
DISCUSSION:
This manuscript discusses principles of knowledge transfer in surgery including evaluation of recommended changes that can improve quality of health care in routine surgical practice. Skills, process and evaluation are carefully described. Continuous information delivery is required to enable surgeons to improve knowledge transfer and to keep up to date their knowledge.

via Knowledge transfer in surgery: skills, … [Ann R Coll Surg Engl. 2007] – PubMed – NCBI.

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RESOURCE: The newest revolution in higher ed

In 1837, the Massachusetts Board of Education devoted part of its first annual report to praising a recent classroom innovation called the blackboard. This “invaluable and indispensible” innovation enabled the “rapid and vivid communication of knowledge.” It created opportunities for teachers to engage learners in ways that had been unimaginable just a generation earlier.

The same and more will be said of online learning tools. We are at the beginning of a technology-led revolution in pedagogy: Our innovation is not the blackboard, but instead an evolving suite of tools that allows interactive learning online. While one outcome of this revolution has rightly caught the world’s attention — the power to democratize access to education on a scale never seen in history — we are just as excited about the promise that these new tools hold for colleges and universities throughout the world.

via The newest revolution in higher ed | Harvard University.

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ABSTRACT: A social network of hospital acquired infection built from electronic medical record data

Abstract
Objective Social networks have been used in the study of outbreaks of infectious diseases, including in small group settings such as individual hospitals. Collecting the data needed to create such networks, however, can be time consuming, costly, and error prone. We sought to create a social network of hospital inpatients using electronic medical record (EMR) data already collected for other purposes, for use in simulating outbreaks of nosocomial infections.

Materials and methods We used the EMR data warehouse of a tertiary academic hospital to model contact among inpatients. Patient-to-patient contact due to shared rooms was inferred from admission-discharge-transfer data, and contact with healthcare workers was inferred from clinical documents. Contacts were used to generate a social network, which was then used to conduct probabilistic simulations of nosocomial outbreaks of methicillin-resistant Staphylococcus aureus and influenza.

Results Simulations of infection transmission across the network reflected the staffing and patient flow practices of the hospital. Simulations modeling patient isolation, increased hand hygiene, and staff vaccination showed a decrease in the spread of infection.

Discussion We developed a method of generating a social network of hospital inpatients from EMR data. This method allows the derivation of networks that reflect the local hospital environment, obviate the need for simulated or manually collected data, and can be updated in near real time.

Conclusions Inpatient social networks represent a novel secondary use of EMR data, and can be used to simulate nosocomial infections. Future work should focus on prospective validation of the simulations, and adapting such networks to other tasks.

via A social network of hospital acquired infection built from electronic medical record data — Cusumano-Towner et al. — Journal of the American Medical Informatics Association.

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